A 3-month, randomized, placebo-controlled, neuroleptic discontinuation study in 100 people with dementia: the neuropsychiatric inventory median cutoff is a predictor of clinical outcome.

Ballard, C; Thomas, A; Fossey, J; Lee, L; Jacoby, R; Lana, M; Bannister, C; Mcshane, R; Swann, A; Juszczak, E; O'Brien, J

Journal article

A 3-month, randomized, placebo-controlled, neuroleptic discontinuation study in 100 people with dementia: the neuropsychiatric inventory median cutoff is a predictor of clinical outcome.

Abstract:: BACKGROUND: Although few placebo-controlled neuroleptic discontinuation studies have been conducted in people with dementia, such studies are essential to inform key clinical decisions. METHOD: A 3-month, double-blind, placebo-controlled, neuroleptic discontinuation study (June 2000 to June 2002) was completed in 100 care-facility residents with probable or possible Alzheimer's disease (according to National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association criteria) who had no severe behavioral disturbances and had been taking neuroleptics for longer than 3 months. The Neuropsychiatric Inventory (NPI) was used to measure changes in behavioral and psychiatric symptoms. Quality of life was evaluated using Dementia Care Mapping. RESULTS: Eighty-two patients completed the 1-month assessment (36 placebo, 46 active). The number of participants withdrawing overall (N = 14 [30%] placebo, N = 14 [26%] active treatment) and because of exacerbation of behavioral symptoms (N = 6 [13%] placebo, N = 5 [9%] active treatment) was similar in the neuroleptic- and placebo-treated patients. As hypothesized, patients with baseline NPI scores at or below the median (< or = 14) had a particularly good outcome, with a significantly greater reduction of agitation in the patients receiving placebo (Mann-Whitney U test, z = 2.4, p =.018), while patients with higher baseline NPI scores were significantly more likely to develop marked behavioral problems if discontinued from neuroleptics (chi(2) = 6.8, p =.009). There was no overall difference in the change of quality of life parameters between groups. DISCUSSION: A standardized evaluation with an instrument such as the NPI may be a clinical indicator of which people with dementia are likely to benefit from discontinuation of neuroleptic treatment.

Publication status:: Published

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APA Style

Ballard, C., Thomas, A., Fossey, J., Lee, L., Jacoby, R., Lana, M., Bannister, C., Mcshane, R., Swann, A., Juszczak, E., & O'Brien, J. (2004). A 3-month, randomized, placebo-controlled, neuroleptic discontinuation study in 100 people with dementia: the neuropsychiatric inventory median cutoff is a predictor of clinical outcome. Journal of Clinical Psychiatry, 65(1), 114–119.

MLA Style

Ballard, C., et al. “A 3-Month, Randomized, Placebo-Controlled, Neuroleptic Discontinuation Study in 100 People with Dementia: the Neuropsychiatric Inventory Median Cutoff Is a Predictor of Clinical Outcome.” Journal of Clinical Psychiatry, vol. 65, no. 1, 2004, pp. 114–19.

Chicago Style

Ballard, C, A Thomas, J Fossey, L Lee, R Jacoby, M Lana, C Bannister, et al. 2004. “A 3-Month, Randomized, Placebo-Controlled, Neuroleptic Discontinuation Study in 100 People with Dementia: the Neuropsychiatric Inventory Median Cutoff Is a Predictor of Clinical Outcome.” Journal of Clinical Psychiatry 65 (1): 114–19.
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